Evaluation of poisoned children with calcium channel blockers or beta blockers drugs

Abstract

Aim: Calcium channel blockers (CCB) and beta blockers (BB) are primarily used to treat hypertension. Overdose of these medications can occur by accidental ingestion or ingestion for suicide attempt. Morbidity and mortality are higher in these poisonings compared to other poisonings. In this study, BB or CCB drug poisoning cases are discussed and the literature is reviewed.

Material and Method: Between January 2011 and July 2012, 590 cases of drug poisoning were admitted in the Pediatric Intensive Care Unit. In this study, 16 of these 590 subjects who were poisoned with calcium channel blockers or beta blockers were evaluated. 11 (68.8%) patients were female and 5 (31.2%) were male. Mean age of the patients was 11.8 +/- 5.94 (2.5-18) years.

Results: Hypotension was the most common clinical sign in CCB poisoning. Two patients were asymptomatic. On ECG, QT prolongation was found in four patients, AV block was found in two patients and ST depression was found in one patient. Nausea, vomiting, hypotension, lethargy and tremor were the most common clinical findings in patients with BB intoxication. Although seven patients had normal ECG, one patient had QT prolongation and one patient had Wolff-Parkinson-White syndrome. Only dopamine was given to two patients with CCB poisoning, dopamine and dobutamine were given to one patient and dopamine, dobutamine, epinephrine, norepinephrine, glucagon and insulin were given to another patient. Inotropic drugs were not given to any patient with BB poisoning. IV Ca-gluconate was given to all patients with CCB poisoning except two patients who were asymptomatic. 15 patients were discharged, while one patient with CCB poisoning was lost.

Conclusions: Because the prognosis of CCB or BB poisoning may be very severe, these patients should be followed up in a fully-equipped pediatric intensive care unit.